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Advanced RCC (advanced + rcc)
Selected AbstractsMicroscopic hematuria as a screening marker for urinary tract malignanciesINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2001Kazunobu Sugimura Abstract Background: Although a mass screening urinalysis is a widely accepted procedure, it has not yet been shown if microhematuria is an appropriate and useful screening marker for urologic malignancies. Methods: (1) The incidence of hematuria was studied in 113 patients with renal cell carcinoma (RCC), 185 with bladder carcinoma and 51 with renal pelvic or ureteral carcinoma. The association of the T stage with the intensity of hematuria in each malignancy was also examined. (2) In 823 asymptomatic adults with microhematuria, the prevalence of these malignancies was studied retrospectively to find the positive predictive value (PPV). Results: (1) The incidence of hematuria was 35% for RCC, including gross and microhematuria. Advanced RCC (T3 and T4) were diagnosed more frequently in the gross hematuria group than in the microhematuria and no hematuria groups. In contrast, the incidence of hematuria was 94% for urothelial carcinomas either in the upper urinary tract or in the bladder. There was no significant difference in the T stage nor grade between the gross hematuria group and the microhematuria group. (2) Regarding asymptomatic microhematuria, the PPV was 1.7% (14 cases) for bladder carcinoma, 0.4% (3 cases) for ureteral/renal pelvic carcinoma and 0.2% (2 cases) for RCC. In men aged 50 years or older, PPV was 6.2% for urothelial carcinomas. In 14 cases of bladder carcinoma, 3 cases showed muscle invasion. Conclusions: Microhematuria is an appropriate screening marker for urothelial carcinomas, particularly in elderly men, but not for RCC. However, it is unlikely that a mass screening urinalysis using a single voided urine sample would contribute to earlier detection of bladder carcinoma. [source] Sunitinib malate in the treatment of renal cell carcinoma and gastrointestinal stromal tumor: Recommendations for patient management,ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 4 2007Jayesh DESAI Abstract Sunitinib malate (SU011248, Sutent®[Pfizer]) is an oral multitargeted tyrosine kinase inhibitor with efficacy against renal cell carcinoma (RCC) and gastrointestinal stromal tumor (GIST). Sunitinib has been approved by various regulatory authorities for treatment of advanced RCC and unresectable and/or malignant GIST following failure of imatinib mesylate treatment due to resistance or intolerance. Sunitinib is generally well tolerated, with most side-effects being mild to moderate. The most common adverse events are lethargy, diarrhea, stomatitis, hand,foot syndrome and hypertension. Uncommon but important adverse effects are hypothyroidism and hematological toxicity (neutropenia and thrombocytopenia), which require monitoring. Caution is recommended when using concurrent inhibitors or inducers of CYP3A4. The frequency and severity of side-effects often correlates with increased drug exposure. In clinical trials, side-effects seldom led to treatment discontinuation. This paper summarizes the published literature and provides recommendations for patient assessments and management of treatment-related side-effects. [source] Advanced-stage renal cell carcinoma treated by radical nephrectomy and adjacent organ or structure resectionBJU INTERNATIONAL, Issue 2 2009Michael E. Karellas OBJECTIVE To examine the effect of radical nephrectomy (RN) with adjacent organ and structure resection on survival, as invasion of adjacent organs in patients with renal cell carcinoma (RCC) is rare. PATIENTS AND METHODS After institutional review board approval, we reviewed our database and statistically analysed of patients with pathological stage T3 or T4 RCC who had RN and resection of a contiguous organ or structure. RESULTS We identified 38 patients of 2464 (1.5%) who had RN with adjacent organ or structure resection. The median (interquartile range) size of the mass was 11 (8,14) cm, and the follow-up 13 (5,33) months. Most patients (68%) were pT4 stage and had conventional clear cell carcinoma (95%). Fourteen patients (37%) had positive surgical margins. The liver (10) was the most commonly resected adjacent organ or structure. Only one patient remains alive with no evidence of disease at 5 years, while three are currently alive with disease. Overall, 34 of 38 patients (90%) ultimately died from disease at a median (range) of 11.7 (5.4,29.2) months after surgical resection. The surgical margin status was the only statistically significant factor for recurrence and death (P = 0.006). CONCLUSIONS The prognosis for patients with advanced RCC and adjacent organ or structure involvement is extremely poor and similar to that of patients with metastatic disease. These patients should be thoroughly counselled about the impact of surgical management and considered for entry into neoadjuvant or adjuvant clinical trials with new targeted systemic agents. [source] Outcome and survival with nonsurgical management of renal cell carcinomaBJU INTERNATIONAL, Issue 7 2003A.D. Baird OBJECTIVE To document long-term survival in patients with renal cell carcinoma (RCC) in whom the primary tumour was left in situ and treatment limited to palliative and symptomatic measures. PATIENTS AND METHODS All patients with a diagnosis of RCC from January 1994 to January 1999 and in whom the primary tumour was left in situ were identified from hospital records (nine women and 16 men, mean age 69 years). The tumour stage was T1,T4. RESULTS The mean survival overall was 19.3 months; patients with locally advanced disease, i.e. stage , T3a, had a mean survival of 16.9 months. CONCLUSIONS There is renewed interest in the management of advanced RCC, with data supporting cytoreductive nephrectomy with systemic biological therapy. These results confirm that such patients with or without metastatic disease can survive for a considerable period with no aggressive surgical or systemic measures, and such intervention may offer no significant advantage in outcome and survival over supportive treatment alone. [source] Targeted inhibition of mammalian target of rapamycin for the treatment of advanced renal cell carcinomaCANCER, Issue 16 2009Anil Kapoor MD Abstract Clinical trials have validated the importance of mammalian target of rapamycin (mTOR) as a targeted mechanism in the treatment of renal cell carcinoma (RCC). Temsirolimus, an mTOR inhibitor that is approved for treatment of advanced RCC, has demonstrated both overall survival benefits and progression-free survival benefits versus interferon,, as first-line treatment for patients with poor prognostic features. Exploratory subset analyses indicated that temsirolimus benefits patients with RCC regardless of tumor histology or nephrectomy status. Everolimus, the second mTOR inhibitor to demonstrate activity in RCC, improved progression-free survival versus placebo in patients whose disease progressed after treatment with vascular endothelial growth factor receptor tyrosine kinase inhibitors (sunitinib, sorafenib, or both); benefit was observed for all risk groups. Deforolimus also exhibited antitumor activity against RCC in early clinical studies. There is now compelling clinical evidence for the effectiveness of targeting mTOR in the treatment of RCC. Cancer 2009. © 2009 American Cancer Society. [source] | ||||||||||||||||||||||